Background: Little
is known about the harmfulness perceptions of e-cigarettes (ECs) outside of
high-income countries. This study examined reasons for EC use and harmfulness
perceptions of ECs compared to regular cigarettes among smokers in Brazil,
where 18.3% of smokers and 2.2% of non-smokers have tried ECs.

Methods: Data
were from Waves 2 (2012-13) and 3 (2016-17) of the International Tobacco
Control (ITC) Brazil Survey, a cohort survey of 1200 adult smokers and 600
non-smokers in Rio de Janeiro, São Paulo, and Porto Alegre. At Wave 3, EC users
(those who used ECs daily, weekly, monthly, and less than monthly; total n=48)
were asked why they started and reasons for using ECs. At Waves 2 and 3, smokers
who had ever heard of ECs (N=392 at Wave 2; N=859 at Wave 3) were asked whether
they thought ECs are more, less, or equally harmful as regular cigarettes.

Results: Among
the 43 smokers who reported using ECs, the most common reasons for using
e-cigarettes were: “using ECs is less harmful than smoking to other people” (69.3%),
“out of curiosity” (59.4%), “they may not be as bad for your health” (59.0%), and
“as a way to help you quit” (57.5%). Between 2012-13 and 2016-17, the percentage
of smokers who “don't know” about the relative harmfulness of ECs decreased
(41.6% to 28.0%; p< .001) and the percentage who believed that ECs are
equally or more harmful than cigarettes increased (22.7% to 35.2%; p< .001).

Conclusions: Smokers
using ECs most commonly use ECs to reduce harm to others, reduce harm to their
own health, and to help them to quit smoking. More smokers now have an opinion
about the relative harmfulness of ECs, and a greater percentage of smokers now incorrectly
believe that ECs are equally or more harmful than cigarettes.